from the studio to the operating room

sketchnoting

Sketchbooks come in every imaginable size, binding and paper to suit any purpose. Coupled with my stationery obsession, I have more sketchbooks than I will ever need or use. One limitation to the sketchbooks, in all their variety, is the lack of customization. You are essentially stuck with whatever order your drawings are in and whatever paper is in that sketchbook.

I came across the Arc Customizable Notebook system from Staples a few months ago. It has been amazing for my Bullet Journal. It contains 8 rings, a durable poly or leather cover and pages that can be moved around. Like a binder in its flexibility but feels like a notebook. I’ve recently thought of applying it to a surgical sketchbook for use as I transition into practice.

Here’s what one will need:

Small Arc Notebook (6-3/8″ x 8-3/4″)

Poly cover – $7.99 USD

Leather cover – $16.99

Tab dividers – $4.99

Arc System Desktop Punch – $42.99 (whoa!)

Lined paper for written notes

Comes with notebook

Sketchbook paper of choice

For me, it’ll be mostly white paper and a few pages of toned paper

8.5″ x 11″ 45-lb white paper for dry media (cut in half)

My sketchbook will contain sketches for common surgeries, divided into 5 main sections. I have been dragging my feet on this due to the desktop punch. Not only is it pricey, it is also heavy as sin. And I’ll be transporting it across the country for the big move after fellowship.

This book will serve as my own personal surgical atlas and flexible enough to make changes as my techniques evolve.

To date, I’ve spoken to three groups of surgeons and trainees, as well as other individuals about the use of drawing for surgical education, documentation and generally “figuring stuff out”. The most common response is, “I can’t draw.” This is coming from surgeons who have two fully-functioning hands, trained for years to operate and have fine motor skills better than the majority of the general population. And yet, the act of drawing is what they do with the scalpel or Bovie (a.k.a. electrocautery tool) in the operating room. For me, I had an inherent fear of drawing until my early thirties. In the end, it took an influential mentor, supportive family and friends, an art class, a sketchbook and the will to try.

It was a mental hurdle, rather than a lack of ability.

Here are 10 steps for anyone to overcome their fear of drawing:

Forget about perfection.

Buy a notebook – Something that is nice enough that you’ll want to use it but not so expensive that you’ll be afraid to use it (ahem, Moleskin). I started off with a regular $2 lined notebook from Staples. I made both written + visual notes and found the lines were less intimidating than blank pages.

Get into a routine of drawing (daily if possible) – This could mean taking 5 minutes at the beginning or end of your day. The key is making it a habit.

Roughly outline the image(s) first and fill in the finer details later – Do this without erasing anything at first. You can always return to this later with a darker pencil or pen over your outline, erasing mistakes later. The key is getting it down when your memory is fresh.

Draw from reference photos or other stationary objects – Learning to draw is not just about mark-making but also honing your skills of observation. Photos and stationary objects will give you more time to observe. For instance, those who are learning to draw figures might go to a museum or gallery to learn on statues first.

Listen to music – This might help for some distraction and “loosen” you up.

Take beginner drawing class or buy a beginner drawing book – I prefer the art class, since it gave me a chance to be among other beginners and realize that I’m not totally off. They might get you to do some exercises to loosen up and be freer with your drawing, depending on the instructor. I found this to be immensely helpful.

Show your work to (supportive) family and friends – Depending on who they are, you might have to be a bit selective on this one. People are generally very encouraging and not expecting you to be Michelangelo.

Deconstruct your subject – Breaking down the object into simple geometric shapes is what many experienced artists still do and makes drawing much more accessible to novices. Then for shading, breaking tones down into 5-6 discreet tones will add realism (but not a necessity at this stage).If you can simplify it, then do so.

Accept that you will never be done – Along the same vein as “Forget about perfection”, there is always something that you could add or change. If you accept that you’ll stop at (arbitrarily) 50% or 75% or 80% of completion, then it will allow you to move on.

Do you have any other tips to share? If so, leave a comment or share them with me @SurgicalArt on Twitter. Oh yes, I’m on Twitter now. Something I never thought I would say.

Sketchnoting is a term used to describe visual note-taking. Complex concepts can be mapped out, linking ideas in a visual manner. Sylvia Duckworth has an amazing presentation, which can be found here, detailing how to get started with sketchnoting. It can be used for taking notes in a lecture, boardroom meeting, while travelling, etc. As mentioned in previous posts, I have been using sketchnoting for the past year of surgical fellowship training — before I knew there was a term for it! Next year, I plan to start a Master’s degree in Bioethics and am interested in how to draw abstract philosophical concepts (but I will try!). When taking junior residents through cases, it is particularly difficult to give direction to them when both my hands are occupied. For example, a hernia sac dissection during an orchidopexy is one such time. I can tell them what to grab and how to move their hands. It is so much more instructive to explain not only how they should handle the tissue but also why they are doing it, based on the anatomy. Therefore, I try to show them drawings like this before the case.

Here’s a key step where the hernia sac is being separated from the spermatic cord during an orchidopexy (= surgery to bring a testicle down to the scrotum in boys whose testicle(s) never fully came down). I like to show them this before our first case together to illustrate how and why we do this step. It is also a better time for them to take in the information, as opposed to operating, listening and learning all at once!

Hernia sac dissection – This sketch illustrates how the hernia sac envelopes the spermatic cord (like an “omega”). It also demonstrates how one applies traction and counter-traction, as well as what instruments are used.Hernia sac dissection – this demonstrates what the left and right hands are doing, which I’ve dubbed the “dog paddle”, during a hernia sac dissection. It’s key to hand the sac to the assistant, so the sac can be rolled off the spermatic cord.